Dental Health Services
Super SmartSmile
- Low copayments
- Access to network of quality assured dentists
- Fully disclosed coverages and copayments
- Coverage for pre-existing conditions
- No deductibles, claim forms, waiting periods or maximums
- Orthodontic coverage
See fee schedule for details.
| Common procedures: | |
|---|---|
| Cleaning: | No charge |
| White Filling: | $20 |
| Crown: | $390* |
| Root Canals: | From $100 |
| Simple Extractions: | No charge |
| Plan Maximum: | There is a $1,000 maximum benefit per member, per contract year, excluding orthodontics The maximum benefit for pedodontic specialty care is $500 per lifetime |
| Waiting Periods: | None |
| Deductible: | None |
| Details: |
|---|
| Fee Schedule | Dentist Search | Exams: |
| No charge for Periodic oral evaluation Office visit copay – $4 | Cleanings: |
| No charge for Adult Prophylaxis (cleaning) limited to once every six months | X-Rays: |
| No charge for bitewing x-rays – 1 to 4 films No charge for panoramic film once in three (3) years per person | Fillings: |
| No charge for Amalgam filling-one surface, primary or permanent $20 for (white filling) Resin-based composite-one surface, anterior $85 for Resin-based composite-one surface, posterior | Extractions: |
| No charge for (Simple) Extraction, erupted tooth or exposed root | Crowns: |
| $390* for crown-porcelain fused metal $240 for crown – porcelain/ceramic See complete fee schedule for different types of crowns covered *Copayments include charges for noble and high noble metal/titanium | Root Canals: |
| $100 for endodontic (root canal) therapy-anterior $300 for endodontic (root canal) therapy-molar | Dentures: |
| $310 for complete denture (maxillary) $310 for complete denture (mandibular) *Replacements limited to every five years | Deep Cleanings: |
| $45 for Periodontal maintenance | Implants: |
| $1,500 for surgical placement of implant body | Braces/Orthodontia: |
| $2,175 for full banded – adult $1,975 for full banded – child, up to age 19 | Teeth Whitening: |
| $100 external bleaching – per tooth $100 internal bleaching – per tooth $200 external bleaching – per arch | Additional Network Information: |
SmartSmile members may choose any of the conveniently located dental offices from your Dental Health Services Directory of Participating Dentists. All dental care must be rendered by your selected dentist, except in the case of an out-of area emergency. You may change your dentist by calling your Member Service Specialist. Exclusions and Limitations: N/APrivacy Policy Plan Brochure |
FAQ:
Can I change my dentist once I am in the plan?
You may change your selected dentist every month while you are covered under the plan by contacting Dental Health Services by the 15th of the month; your change will be made effective the first of the following month.
What is a pre-existing condition versus work-in-progress? Is it covered?
Pre-existing condition is a term that refers to any dental or oral health condition (such as a cavity) that existed before you enrolled in your Super SmartSmile dental plan. Once you have your new dental coverage with Dental Health Services, ALL pre-existing conditions ARE COVERED, if the service needed is a covered benefit.
Work in progress refers to dental treatment that is in the process of being completed. Under certain specific circumstances, work in progress is covered under your Super SmartSmile plan. Under most circumstances, work in progress is NOT covered.
What provider options do I have?
Super SmartSmile plan members may choose any of the conveniently located dental offices from your Dental Health Services Directory of Participating Dentists. All dental care must be rendered by your selected dentist, except in the case of an out of area emergency. You may change your dentist by calling your Member Service Specialist.
When can I start using my Plan?
You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.
When will I receive my new member kit and what will it include?
Your Super SmartSmile plan enrollment package will be sent to you within 10 business days. You can expect to receive a copy of your Super SmartSmile plan copayment schedule, your Evidence of Coverage brochure and your personal membership card.
Who can enroll in this plan?
You and your dependents, including children through 25 years of age and your spouse or domestic partner.
Suite 334
Portland, OR 97202
Disclaimers and Disclosures:
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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